Sudden scrotal edema:old pearls?
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Biomedical subjects
Publications and source records attributed to L B Seeff.
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Primary biliary cirrhosis is infrequently diagnosed in men, so that the clinical, biochemical and histopathological spectrum of this disease in men has not been evaluated. Therefore, we studied 30 men who had a histological diagnosis of primary biliary cirrhosis and had positive tests for antimitochondrial antibodies. Five patients had no hepatobiliary symptoms, and two of these patients had neither biochemical nor histological evidence of cholestasis. These 30 male patients' findings were compared with the findings in 30 age-matched women who also had primary biliary cirrhosis and antimitochondrial antibodies. Six of these patients were asymptomatic. Clinical findings and symptomatic status, in addition to biochemical and histopathological features, were generally similar in both male and female patients. The possible significance of higher serum alkaline phosphatase activities and lower frequency of occurrence of piecemeal necrosis in men with primary biliary cirrhosis, as compared with women, requires further study.
Hepatitis B virus and hepatitis delta virus co-infection in drug addicts has been well described in Europe, the latter agent appearing to have been introduced there in the mid-1970's. Currently, similar data are scanty among United States addicts. We therefore reevaluated 99 drug addicts from three different geographic locations in the United States who had participated in a Veterans Administration Cooperative Study between 1972 and 1975. Almost all were asymptomatic, and all had been subjected to liver biopsy because of prolonged aminotransferase abnormalities. Stored sera were tested for antibody to hepatitis delta antigen (anti-HD) by radioimmunoassay and available liver biopsies examined for hepatitis delta antigen (HDAg) by immunofluorescence. Overall, 19.2% were HBsAg positive, 9.1% HBeAg positive, 90% anti-HBc positive and 10.1%, positive for anti-HD. Anti-HD was identified in 42.1% of addicts who were HBsAg positive and in 3.3% who were anti-HBs positive. No correlation was found between HBeAg and anti-HD, but anti-HD was present significantly more frequently in those with chronic active hepatitis than in those with chronic persistent hepatitis. We conclude that hepatitis delta virus infection is common in HBsAg-positive drug addicts in the United States dating back to at least 1972 and probably earlier.
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Occasional discordant results on testing samples by radioimmunoassay for hepatitis B surface antigen and antibody led to this analysis of gamma counters used by different hospitals and testing laboratories. Eight dilutions of purified 125I were sent under code to 11 institutions doing radioimmunoassay testing. Results demonstrated a wide range in background counts-per-minute (cpm) as well as considerable variation between gamma counters in per cent counting efficiency for 125I (ranging from 20 to 48%). These data support the need for regular monitoring and calibration of gamma counters to ensure low background cpm as well as maximum counting efficiency. This will give reproducible and reliable results in radioimmunoassay testing.
The Veterans Administration is currently conducting a collaborative study in three hospital-based drug treatment clinics to evaluate asymptomatic parenteral drug addicts for evidence of hepatic disease. Preliminary data are presented on 347 patients who have completed at least three months of follow-up evaluation. On admission, abnormal serum transaminase values were demonstrated in one half, HBs Ag in 7 per cent, and anti-HBs in 59 per cent. The frequency of these findings increased during the follow-up evaluation, only 19 (5.5 per cent) remaining entirely free of one or more of these abnormalities. Definable hepatologic disease (acute or chronic hepatitis, alcoholic hepatitis) developed in 46 per cent of the patients. However, among 60 of them subjected to liver biopsy, a poor correlation was noted between the clinical and histologic diagnoses. In particular, routine liver function and immunologic tests did not discriminate between histologically detected chronic active and chronic persistent hepatitis. However, HBs Ag was present significantly more frequently in those with chronic active hepatitis. Wide variability of histologic diagnoses was seen among patients subjected to more than one biopsy, apparent progression and regression of the lesion being noted. This demonstrates the hazard of attempting to assign a prognosis to the disease on the basis of a single liver biopsy specimen, and suggests that repeated biopsies should be mandatory for the evaluation of chronic liver disease in drug addicts.
The Veterans Administration has been conducting a cooperative randomized, double-blind, controlled trial to evaluate the efficacy of conventional and hepatitis B immune serum globulin for the prevention of post-transfusion hepatitis. Data collected between 1969 and 1974 provide the opportunity to describe the annual incidence and characteristics of the hepatitis that has developed, and the risk factors which have been identified. Anicteric hepatitis has developed four times more frequently than icteric hepatitis, the total incidence for all six years being 11.3 per cent. The incidence of HBs Ag-associated hepatitis declined dramatically after 1973 with the institution of routine screening of donor blood by radioimmunoassay techniques, although no change in the incidence of antigen-negative hepatitis has occurred. There is indirect evidence to suggest that an undefined agent is responsible for the majority of instances of post-transfusion hepatitis occurring presently. The most important risk factor responsible for the development of hepatitis is the use of commercial blood, and it is strongly urged that this form of blood be removed from general use.